Ready to sign up?

Ready to sign up?

Have your Medicare ID card handy, and let's get started!

Choose the way to enroll that's best for you.

Paper: Use the paper enrollment form

that is included in this enrollment kit. Once you are done filling it out, you can mail the form to FHCP Medicare. (One form must be filled out for each person who enrolls.)

Online: Use the online form at

. You'll be guided through the process of completing and submitting the enrollment form and the system will prompt you if you left anything missing or incomplete.

Licensed Sales Agent: An agent can help

you choose the best plan for YOU and can also offer you help in filling out and submitting the enrollment form. The agent will be employed by or contracted with FHCP Medicare and may be paid based on your enrollment in a plan.

? Visit your local FHCP Welcome Center or agent; or

? Call and speak with one of our agents at 1-855-462-3427 (TTY 1-800-955-8770.)

Helpful tips for filling out your enrollment form.

3 N o matter which way you choose to enroll, make sure you don't skip any sections.

If you leave out information, it may delay your start date.

3 W hen choosing a plan, select only ONE plan name. 3 W here requested, be sure to fill in the Part A and Part B effective dates from your

Medicare ID card.

3 If you choose an HMO plan, write in your choice for a primary care physician (PCP).

If you do not write in your choice for a PCP, one will be assigned to you.

3 If you are not signing up between October 15 and December 7, be sure to complete

the "Attestation of Eligibility for an Enrollment Period" section.

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